R. J. Ellis1,2, D. Hewitt3, Y. Hu1, A. D. Yang1, J. T. Moskowitz4, E. O. Cheung4, D. B. Hoyt2, J. Buyske5, T. J. Nasca6, J. R. Potts6, K. Y. Bilimoria1,2 1Northwestern University,Department Of Surgery, Surgical Outcomes And Quality Improvement Center,Chicago, IL, USA 2American College of Surgeons,Chicago, IL, USA 3Thomas Jefferson University,Department Of Surgery,Philadelphia, PA, USA 4Northwestern University,Department Of Medical Social Sciences,Chicago, IL, USA 5American Board of Surgery,Philadelphia, PA, USA 6Accreditation Council for Graduate Medical Education,Chicago, IL, USA
Introduction: Poor physician wellness often manifests as burnout and may lead to thoughts of attrition and suicidal ideation, with suicide a leading cause of physician mortality. Surgical residents may be particularly at risk for these issues. Objectives of this study were (1) to examine the frequency of burnout, thoughts of attrition, and suicidal ideation in general surgery residents and (2) to characterize individual and environmental factors associated with poor wellness outcomes.
Methods: Cross-sectional national study of clinically active general surgery residents administered in conjunction with the 2018 American Board of Surgery In-Training Examination. Outcomes of interest were burnout, thoughts of attrition, and suicidal ideation. Individual resident and environmental factors associated with resident wellness included resident grit, stress, duty hour violations, discrimination, abuse, and sexual harassment. Associations between exposures and outcomes were assessed using multivariable logistic regression models.
Results: Among 7,413 residents (99.3% response rate) from 262 general surgery programs, 12.9% of residents reported at least weekly symptoms on both burnout subscales (emotional exhaustion and depersonalization). Burnout was more likely in residents with low grit scores (OR 2.27 [95%CI 1.95-2.63]), frequent duty hour violations (OR 1.46 [95%CI 1.22-1.74]), and in those reporting discrimination (OR 1.23 [95%CI 1.02-1.49]), verbal/physical abuse (OR 1.78 [95%CI 1.47-2.15]), or sexual harassment (OR 1.28 [95%CI 1.00-1.63]). Thoughts of attrition were reported by 12.6% of residents and were more likely in female residents (OR 1.32 [95%CI 1.09-1.60]), those with lower grit scores (OR 1.26 [95%CI 1.06-1.50]), frequent duty hour violations (OR 1.68 [95%CI 1.38-2.04]), or in those reporting severe stress (OR 2.47 [95%CI 2.04-2.99]), frequent burnout symptoms (OR 2.35 [95%CI 1.92-2.87]), discrimination (OR 1.27 [95%CI 1.06-1.51]), or verbal/physical abuse (OR 2.16 [95%CI 1.81-2.57]). Suicidal ideation was reported by 4.5% of residents and was more likely in those with lower grit scores (OR 1.43 [95%CI 1.10-1.84]), or in those who reported severe stress (OR 2.61 [95%CI 1.99-3.42]), frequent burnout symptoms (OR 1.94 [95%CI 1.43-2.63]), verbal/physical abuse (OR 1.80 [95%CI 1.39-2.33]), or sexual harassment (OR 1.58 [95%CI 1.13-2.21]).
Conclusion: Burnout symptoms, thoughts of attrition, and suicidal ideation were reported at lower rates in this comprehensive national survey than in previous studies, but remain an important problem among general surgery residents. Resident grit and environmental factors such as duty hour violations, discrimination, abuse, and harassment are associated with burnout. Burnout and negative environmental factors are further associated with thoughts of attrition and suicidal ideation. Targeted interventions aimed at minimizing inappropriate behaviors and improving the learning environment may improve trainee wellness.